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Medicare Supplement Insurance — High Deductible Plan F

Get a no-obligation quote for Medicare Supplement coverage from Blue Cross and Blue Shield of Illinois

If you are willing to share certain health care costs, this Medicare Supplement insurance plan can help you save on premiums while still receiving dependable coverage.

High Deductible Plan F includes cost-sharing features that allow you to save on premiums while still receiving dependable coverage. For more detailed information about cost, coverage and renewability, click on the sections below.

This high deductible Medicare Supplement insurance plan pays the same benefits as Plan F after you have paid a calendar-year $2,180 deductible.

Benefits from the High Deductible Plan F will not begin until out-of-pocket expenses are $2,180.

Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy, which includes the Medicare deductibles for Part A and Part B, but not the separate foreign travel emergency deductible.

Other costs you can expect to pay with High Deductible Plan F:

Part B deductible

All costs beyond the additional 365 days after the Lifetime Reserve are used

All costs after 101 days in a skilled nursing facility

Foreign travel: $250 per calendar year; 20 percent of costs within the first $50,000; all costs thereafter

For more information on costs, get a quick quote or see the Medicare Supplement Outline of Coverage.

The cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends

$147 Part B Medicare deductible

Your Part B coinsurance and the cost of the first three pints of blood

100 percent of Part B physician charges that are in excess of the Medicare-approved amount (by law no physician may charge more than 115 percent of Medicare-approved amounts).

Skilled nursing facility copayment

Hospice care

Foreign travel emergency care*

More Plan Details

It's important to know the critical features of the Medicare Supplement insurance plan you are considering. The Outline of Medicare Supplement Coverage provides brief descriptions of the basic provisions of the Medicare Supplement insurance plans, as well as details on policy renewability, benefit exclusions and coverage limitations.

* Plans cover medically necessary emergency care services needed immediately because of an injury or illness of sudden and unexpected onset, beginning during the first 60 days of each trip outside the USA.

Blue Cross and Blue Shield of Illinois (BCBSIL) will never terminate or refuse to renew your Medicare Supplement insurance policy because of the condition of your health. However, to protect you and the rights of all policy holders, there are situations when a Medicare Supplement insurance plan may be terminated or a renewal refused:

Failure to pay

The Medicare Supplement insurance plan is discontinued (90 days notice given with an option to convert to any plan we offer)

Discovery of fraud or an intentional misrepresentation of facts (30 days prior written notice given)

If you no longer reside, live or work in an area where we are authorized to do business

For more information on renewability, see the Outline of Medicare Supplement Coverage that is available when you get a quote.

HOSPITALIZATION*: Semi-private room and board, general nursing, and miscellaneous services and supplies

First 60 days

All but $1,260

$1,260 (Part A Deductible)

$0

61st through 90th day

All but $315 a day

$315 a day

$0

91st day and after:— While using 60 Lifetime Reserve days— Once Lifetime Reserve days are used:Additional 365 days

All but $630 a day

$0

$630 a day

100% of Medicare-eligible expenses

$0

$0***

Beyond the additional 365 days

$0

$0

All costs

SKILLED NURSING FACILITY CARE*: You must meet Medicare's requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days after leaving the hospital

First 20 days

All approved amounts

$0

$0

21st through 100th day

All but $157.50 a day

Up to $157.50 a day

$0

101st day and after

$0

$0

All costs

BLOOD

First three pints

$0

Three pints

$0

Additional amounts

100%

$0

$0

HOSPICE CARE: You must meet Medicare's requirements, including a doctor's certification of terminal illness

All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care

Medicare copayment/coinsurance

$0

* A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

** This high deductible plan pays the same benefits as Plan F after one has paid a calendar-year $2,180 deductible. Benefits from High Deductible
Plan F will not begin until out-of-pocket expenses are $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid
by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan's separate foreign travel emergency deductible.

*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physicians' services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment

First $147 of Medicare-approved amounts*

$0

$147(Part B deductible)

$0

Remainder of Medicare-approved amounts

Generally 80%

Generally 20%

$0

PART B EXCESS CHARGES (above Medicare-approved amounts)

$0

100%

$0

BLOOD

First three pints

$0

All costs

$0

Next $147 of Medicare-approved amounts*

$0

$147(Part B deductible)

$0

Remainder of Medicare-approved amounts

80%

20%

$0

CLINICAL LABORATORY SERVICES—TESTS FOR DIAGONOSTIC SERVICES

100%

$0

$0

* Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

** This high deductible plan pays the same benefits as Plan F after one has paid a calendar-year $2,180 deductible. Benefits from High Deductible
Plan F will not begin until out-of-pocket expenses are $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid
by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan's separate foreign travel emergency deductible.

* Once you have been billed $147 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

** This high deductible plan pays the same benefits as Plan F after one has paid a calendar-year $2,180 deductible. Benefits from High Deductible
Plan F will not begin until out-of-pocket expenses are $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid
by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan's separate foreign travel emergency deductible.

FOREIGN TRAVEL—NOT COVERED BY MEDICARE: Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA

First $250 each calendar year

$0

$0

$250

Remainder of charges

$0

80% to a lifetime maximum benefit of $50,000

20% and amounts
over the $50,000
lifetime maximum

** This high deductible plan pays the same benefits as Plan F after one has paid a calendar-year $2,180 deductible. Benefits from High Deductible
Plan F will not begin until out-of-pocket expenses are $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid
by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan's separate foreign travel emergency deductible.

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Medicare Supplement Insurance Plan Notice:
Not connected with or endorsed by the U.S. Government or the Federal Medicare Program.

Medicare Supplement Insurance plans are offered by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an independent licensee of the Blue Cross Blue Shield Association.